January 2021

2020 (In) Hindsight

By Michael J. Katin, MD

January 1 brings the start of a new year (unless you happen to be Chinese, Hindu, Islam, Bahai, Jewish, Buddhist, Iranian, or probably several hundred other ethnic or religious groups). After all the turmoil of 2020, the world is anticipating that 2021 will bring only good events and major advances in tolerance, understanding, and science. It is appropriate at this time to recognize notable events that occurred in 2020 in science and, particularly, in the oncology field. Yes, it would be, but it appears that the vast majority of effort was dedicated to finding treatment and prophylaxis for COVID-19 or determining how to minimize the impact of COVID-19 when dealing with other diseases. The pandemic did its part in generating a proliferation of journal articles peripheral to the virus itself, producing amplification of CVs.

Several months into the pandemic there was the creation of the CCC19, the Covid-19 & Cancer Consortium, which rapidly spread to include 125 members and which has an absolutely beautiful website and comprehensively keeps track of abstracts, journal articles, editorials, popular media references, and, of course, podcasts The down side is that, for at least the next few months, any meetings of the CCC19 will of necessity need to be held virtually rather than at the traditional, more productive, sites of large resort hotels in intensely academic locations.

The unfortunate fact Is that most of the literature on the subject ("Community Oncologists Take On the Pandemic's Challenges ") dealt with how to take care of patients without getting everybody infected. The revelation that patients with cancer could be more susceptible and affected more intensely by COVID-19 would have been assumed and turns out to be true. The irony is that precautions that should have been in place anyway, knowing the microbial theory of disease, are now being presented as profound new concepts. It almost seems as if influenza and MRSA had been manageable nuisances. Other publications have addressed tailoring treatment to give greatest flexibility in scheduling and, in fact, reducing the frequency of treatment as much as possible to minimize contact----such as in prostate cancer (Zaorsky, NG, et al., "Prostate Cancer Radiation Therapy Recommendations in Response to COVID-19 ") to address surveillance, appropriate use of neoadjuvant hormonal therapy, and hypofractionation---although isn't that what we were supposed to be doing anyway? Finally, there have been multiple publications dealing with the legitimate concern that delay in routine studies will lead to cancers being diagnosed at a most advanced stage, and also the truly first-world problem of the impact the pandemic will have on proton therapy treatment and research.

Since this month's column is supposed to be dealing with advances in oncology rather than holding actions, we should conclude with recognition of developments that truly represent progress. The American Society of Clinical Oncology as named its Clinical Cancer Advances of the Year 2020, and, shockingly, radiation oncology is not mentioned in any of them. What happened to CAR T therapy or targeted therapy? The winner was "Refinement of Surgical Treatment of Cancer," a decision that should encourage a recount

Another major event was the presentation on August 28 by Elon Musk of the Neuralink system, capable of connecting our brains directly to computers. This has multiple potential applications, ranging from solving the problem of physician presence, to expediting the drawing of target volumes for treatment planning, but somehow I think the ramifications are intended to go far beyond that.

One additional event with long-term implications that occurred in 2020 was the discovery that a mycovirus was able to be detected in the blood of all patients with acute lymphoblastic leukemia as opposed to controls. This being promoted as a potential diagnostic tool but also to as another example of Knudson's "two hit" theory of cancer causation, such as having a genetic mutation followed by a somatic mutation that could be caused by................an infection.


Bonus (to make up for last month's anti-vaxxers)

Stick Me With Your Best Shot ( to the tune of "Hit Me With Your Best Shot")

Now there's a big pandemic and there's scientists trying
To come up with a vaccine that will keep us from dying
When they finally get to offer it I'd never decline,
And in fact I'll camp out overnight to be first in line

Stick me with your best shot
I wouldn't want to have a test shot
Stick me with your best shot
Send COVID away!

I don't care if it's the one made by Moderna or Pfizer
Cause once it's in my system I can be a survivor
And if they have informed consent I won't even read it
I'll sign as fast as possible so I can receive it.

Stick me with your best shot
I don't care if my arm gets red hot
Stick me with your best shot
Send COVID away!

If I can't get one in this country I'll go on to Plan B.
I'd take the one from China if they'd give it to me
I'll even go to Russia if it means staying alive
I'll do whatever Putin says to get Sputnik V.

Stick me with your best shot
I hope you put it in the right spot
Stick me with your best shot
Send COVID away!

Asteroid JF1 Countdown: Asteroid JF1 will be impacting with or passing by Earth May 6, 2022, which, counting May 6, is 491 days from now. Plenty of time left to stock up on batteries, plywood, Hostess Twinkies, hand sanitizer, bubble wrap, ammunition, and duct tape.

Emanuel Countdown: Dr. Ezekiel Emanuel's biographies list his birth year as 1957 but, interestingly, had not previously listed a birth date but some now report it as September 6. He has expressed that he does not wish to live past his 75th birthday. If September 6 is correct, he will have his 75th birthday on September 6, 2032. Including his birthday, this leaves 4,267 days to his goal.